Registration of Parent Leaders 2023-2024

Name *

Surnames *

Email *

Town *

Postal Code *

Telephone or cell phone

Are you: *Mother/Father/GuardianProfessionalIntermediate or higher studentPost-secondary studentDisabled personOther

My race is: *WhiteAfrican AmericanNative AmericanTwo races or moreI don't want to disclose itOther

Other

My ethnicity is: *Hispanic or LatinaNot Hispanic or LatinoI don't want to disclose it

Age of the person with disabilities whom I care for or work with: *0 - 1112 -1516 - 21 (is in school)18 or older (left school)

Diagnosis of the person with disabilities. Professionals can write does not apply. *

Race of the person with a disability. Professionals can choose not applicable. *WhiteAfrican AmericanNative AmericanTwo races or moreI don't want to disclose itDoes not applyOther

Other

Ethnicity of the person with disabilities. Professionals can choose not applicable. *Hispanic or LatinaNot Hispanic or LatinoI don't want to disclose itDoes not apply

What motivates you to participate in the parent leaders academy 2023-2024? *

How will you use the information, resources and tools you will obtain at the academy? *

Send

If you have any questions, please call 787-763-4665